Most of the time, the treatment of laryngeal or hypopharyngeal cancer is based on its stage – how far it has spread in the body. But other factors, such as a person's overall health, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.
Laryngeal cancers
Stage 0
These cancers are almost always glottic (vocal cord) cancers that are found early because of voice changes.
This stage is nearly always curable with either vocal cord stripping, laser surgery, or radiation therapy. The patient is then watched closely to see if the cancer returns. If the cancer comes back after stripping or laser surgery, radiation can be used.
Almost all patients at this stage can be cured without extensive surgery. But it is important for them to realize that if they smoke, continuing to do so increases the risk that a new cancer will develop.
Stage I and II laryngeal cancers
Most patients with stage I and II laryngeal cancers can be successfully treated without totally removing their larynx.
Either radiation alone (without surgery) or partial laryngectomy is successful in treating most patients. However, voice results tend to be better with radiation therapy than with partial laryngectomy, and the complication rate for surgery tends to be greater than for radiation treatment alone. Many doctors use radiation therapy for smaller cancers, only using surgery for cancers that come back after treatment.
The treatment for glottic (vocal cord) cancers and supraglottic cancers (those starting above the vocal cords) is slightly different.
Glottic cancers do not usually require further treatment after radiation or surgery unless there are signs the cancer has returned. In fact, some early glottic cancers may be treated by removing the cancerous vocal cord, or even by laser surgery.
Supraglottic cancers are more likely to spread to the neck lymph nodes, so the nodes are often treated as well. If you are having surgery for your tumor, then the surgeon will also likely remove lymph nodes from your neck. If your treatment is to be radiation therapy alone, you will also receive radiation therapy to the lymph nodes in the neck. If, after surgery for a supraglottic cancer, the cancer is found to have features that make it more likely to come back, further treatment such as radiation therapy or chemoradiation may be recommended.
Stage III and IV laryngeal cancers
Stages III and IV laryngeal cancers generally require treatment with some combination of surgery, radiation, and/or chemotherapy.
Unless the cancer is very advanced, initial treatment is usually surgery or chemoradiation. Radiation therapy alone may be an option for people who cannot tolerate more intensive treatments.
Surgical treatment of these tumors is almost always complete removal of the larynx, but a small group of laryngeal cancers may still be treated by partial laryngectomy.
These cancers have a higher risk of spreading to nearby lymph nodes in the neck than earlier stage cancers, so these lymph nodes are often removed along with the tumor if surgery is being used to treat the cancer. Radiation therapy, often given with chemo, may be required after surgery, particularly if the cancer has spread to the lymph nodes or has other features that make it more likely to come back.
Instead of using surgery as the first step, many doctors now prefer to start treatment with radiation and chemotherapy. If any cancer remains after treatment, surgery can then be done to try to remove it. This approach works as well as surgery (laryngectomy) alone to treat the cancer, but it may offer a chance to save the larynx. If the framework of the larynx (such as the thyroid cartilage) has been destroyed by the cancer, the larynx may never work normally again, no matter what treatment is chosen. In these cases, surgery to remove the larynx may be the best treatment approach.
Another option may be to start with chemotherapy alone, which also known as induction chemotherapy. If the tumor shrinks, radiation therapy (sometimes along with more chemo) is then given. If the tumor doesn't shrink, surgery is usually the next treatment. But because some studies have shown better results when radiation is part of the initial treatment, not all doctors agree with the approach of starting with chemotherapy alone.
Cancers that are too large or have spread too far to be completely removed by surgery are often treated with radiation, usually combined with chemotherapy. Sometimes, if the tumor shrinks enough, surgery of lymph nodes in the neck may be an option. But for many advanced cancers, the goal of treatment may be to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.
Hypopharyngeal cancers
These cancers are often harder to treat than laryngeal cancers. Because they do not cause symptoms early, most are diagnosed in an advanced stage. Tumors in this region also have a high likelihood of spreading to the lymph nodes, even when there is no obvious mass in the neck. Because of this risk, treatment of the lymph nodes in the neck is recommended for patients with hypopharyngeal cancer.
Stage I and some early stage II hypopharyngeal cancers
The main options for initial treatment of small tumors are radiation and surgery. Larger tumors are typically treated with surgery.
Surgery would include removing all or part of the pharynx and lymph nodes in the neck. The larynx is sometimes removed as well. Patients who have a high chance of the cancer returning (based on what is found during surgery) may then be treated with radiation or chemoradiation.
Patients who receive radiation as their main treatment will be assessed after the treatment is complete. If there is still cancer in the hypopharynx, surgery will be done.
Stage III and IV hypopharyngeal cancers
These cancers are often treated with extensive surgery followed by radiation alone or chemoradiation.
Another option is to start treatment with chemoradiation. If any cancer remains after treatment, surgery can then be done to try to remove it.
A third option is to give chemotherapy as the first treatment, also known as induction chemotherapy. Chemotherapy is then combined with radiation therapy. If the lymph nodes remain enlarged after chemoradiotherapy, they may be removed with a lymph node dissection.
Cancers that are too large or have spread too far to be completely removed by surgery are often treated with radiation, usually combined with chemotherapy. In some cases, if the tumor shrinks enough, surgery of lymph nodes in the neck may be an option. But for many advanced cancers, the goal of treatment may be to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.
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